People think about addiction in vastly different ways. You could ask five people you work with what addiction is and you'd probably get five different answers. Some of these answers have shortcomings and some answers can be extremely problematic. It is important to discuss varying conceptualizations of addiction because beliefs and attitudes in form action. In other words, your understanding of addiction can impact how you treat those with addiction. So let's take a moment to check the temperature of our learning community. Which of the following statements do you believe is most true? Addiction is solely a matter of choice. Addiction is solely a physiological dependence on a substance. Addiction is solely a brain disease. If none of these felt fully accurate to you, congratulations. These are all myths about addiction that we hope to debunk. By the end of the lesson, you will understand how you think about addiction informs the care you provide. Beyond that, you will walk away with a useful model of addiction that we would like you to apply to the rest of this course and more importantly, in your day-to-day practice. Myth number one, addiction is solely a matter of choice. Yes, some level of personal choice is involved. But many practitioners put too much burden on the individual and forget to consider how the role of social conditions and policy lead to maladaptive substance use. We know that, in fact, social status and context plays a significant role in addiction. Hinging addiction solely on personal choice is indicative of the moral model which dominates how many people view addiction. This model asserts that substance use is a failing and resulting from moral weakness, bad choices or deficits court individual self. This is why you often hear addiction likened to being dirty, while sobriety is often referred to as clean. The moralistic approach can become barriers to treatment. As the person with addiction fears negative consequences such as going to jail losing their job and distancing themselves from loved ones. Let's see what happens if we approach a patient from the moral model. This might sound like a provider saying, it's clear Mr. X that what's going on here is that you are an addict and you need help. Put yourself in the patient's shoes. Would you like to hear that? Is that encouraging or helpful? I've informally surveyed my patients asking them what were their first thoughts when they heard the word addiction or addict? The common responses I got were it makes me feel bad, junkie, loser, dirty. The moral model makes people with substance use issues feel worse about themselves and compounds the problem. Myth number two, addiction is solely physiological dependence. This model seeks to take the burden off choice and highlights the body's natural reward mechanism. While it is true, that continued use leads to dependence even despite harmful effects. That is not the whole story. If addiction was just a matter of dependence, then once the person has detoxed, they'd be free from addiction, but that's not the case. Detox is not a form of treatment for substance use disorders. In some cases, withdrawal is not necessary at all. In other cases, it's just one step and a comprehensive treatment plan that we will outline in later modules. So how does this model manifest clinically? You might be able to spot this when a provider recommends detox as a treatment modality. You might hear Mr. X, because of your substance use you have developed a high tolerance and can go into withdrawal. What you need to do is find a detox facility and go cold turkey. This approach puts all the burden on the patient, ignores the personal goals and removes the provider from the equation. Myth number three, addiction is solely a brain disease. This is similar to the substance dependence view of addiction as it focuses solely on biology of the brain. The downside is it neglects the environmental and social forces apply. And the fact that it involves a continuum and that many individuals recover without treatment. As Carl Hart professor of neuroscience and psychology at Columbia University has said, if the real problem with drug addiction for example is the interaction between the drug itself and the individuals brain. Then the solution to this problem lies in one of two approaches, either remove the drug from society through policies and law enforcement. For example, drug free societies or focus exclusively on the addicted individual's brain as the problem. So what does the brain disease model sound like? It's pretty straightforward. So Mr. X, it's clear that you have an addiction. But since addiction is a brain disease, we will use medication that target the brain to help you manage this addiction. Doesn't sound too bad, right? But this does not address the work the patient needs to do in order to change their behaviors to get back into a healthy routine. So I've just told you that addiction is not just a matter of choice, not just physiological dependence, and not just a disease. While there is truth to those statements which is why they have proliferated. They should not be siloed theories. They should be combined into a comprehensive model. In this course, we theorize that addiction is a chronic, treatable, medical condition. Where we acknowledge the biological, psychological, socio-economic and spiritual dimensions of the disease process. A disease that should not be seen as inevitable or without an element of personal choice. We can't understand the disease without the complex context or contributing factors. With this comprehensive model in mind, let's go back and revise some of the statements we heard earlier. We call what we heard in the moral model. It is clear, Mr. X, that what is going on here is that you are an addict and that you need help. [SOUND] Now compare that to this. Mr. X, what is clear is that you are experiencing a substance use disorder and I can offer some help. In the moral model, the person is an addict and they are labeled. They are deviant. In the second example, they are diagnosed. Substance use disorder does not define them rather is something a person has like other diseases or conditions. Now, let's go back to the physiological dependence model. Mr. X, because of your substance use, you've developed a high tolerance and can go into withdrawal. What you need to do is find a detox facility and go cold turkey. [SOUND] Now compare that to a patient centered approach. Mr. X, depending on your goals, we can explore medically managed withdrawal or review medications that will curb cravings and withdrawal symptoms. Would that be okay if I discuss these options with you? In the physiological dependence model, the sole objective is to get the patient weaned off the substance and then poof addiction's gone. This is unrealistic. What is realistic is factoring the patient's goals, asking their permission and matching them with a menu of various treatment options. And finally, let's review the brain disease model. So Mr. X, it is clear you have an addiction. But since addiction is a brain disease, we will use medications that target the brain to help you manage this addiction. [SOUND] Using the chronic disease model, you might say instead. Based on what you told me, you meet the criteria for a severe substance use disorder. And I know that might be hard to hear but addiction is a chronic disease. Like diabetes, it is treatable. I have some ideas on what might help. May I go over some treatment options with you? Comparing substance use disorders to diabetes helps refocus us on the treatable nature of substance use disorders. With diabetes, the practitioner emphasizes healthy living and eating, the need for medication and monitoring blood glucose and follow-up. Similarly, with substance use disorders, healthy behaviors, medication and engaging in a therapeutic treatment program are essential components. Moving forward, we hope you can acknowledge that addiction is a chronic condition with behavioral components just like diabetes or high blood pressure. And give your patients hope that substance use disorders are treatable and then you are there to help.
